Clinical Significance of Phase Angle in Non-Dialysis CKD Stage 5 and Peritoneal Dialysis Patients

Abstract

Background: Fluid overload and protein-energy wasting (PEW) are common in patients with end-stage renal disease (ESRD) and lead to a poor prognosis. We aimed to evaluate the volume and nutritional status of ESRD patients and to determine the clinical significance of phase angle (PhA). Methods: This study was a cross-sectional comparison of bioimpedance spectroscopy (BIS) findings in patients with non-dialysis chronic kidney disease (CKD) stage 5 (CKD5-ND, N = 80) and age/sex-matched peritoneal dialysis patients (PD, N = 80). PEW was defined as a PhA less than 4.5°. Results: The PhA was found to be positively associated with a geriatric nutritional risk index (GNRI, r = 0.561, p < 0.001), lean tissue index (LTI, r = 0.473, p < 0.001), and albumin (r = 0.565, p < 0.001) while OH/ECW (r = −0.824, p < 0.001) showed an inverse correlation. The CKD5-ND group had more overhydration (p = 0.027). The PD group had significantly higher PhA (p = 0.023), GNRI (p = 0.005), hemoglobin (p < 0.001), and albumin (p = 0.003) than the CKD5-ND group. The cut-off values predicting PEW were found to be 3.55 g/dL for albumin, 94.9 for GNRI, and 12.95 kg/m2 for LTI in PD patients. Conclusions: This study demonstrated that PhA could be used as a marker to reflect nutritional status in patients with ESRD. Since BIS can inform both volume and nutritional status, regular monitoring will provide the basis for active correction of fluid overload and nutritional supplementation, which may improve outcomes in patients with ESRD.

Bed-side measures for diagnosis of low muscle mass, sarcopenia, obesity, and sarcopenic obesity in patients with chronic kidney disease under non-dialysis-dependent, dialysis dependent and kidney transplant therapy

“…Phase angle has been significantly associated with death in NDD treatment CKD patients [ 34 ]. Despite recognized clinical applicability [ 35 ], phase angle did not present good capacity to diagnose low muscle mass and sarcopenia.…”

Phase angle values, a good indicator of nutritional status, are associated with median value of hemoglobin rather than hemoglobin variability in hemodialysis patients

“…demonstrated that PhA was positively associated with a geriatric nutritional risk index, lean tissue index, and albumin level in non-dialytic stage 5 CKD and PD patients. However, there was no association between PhA and Hb level in those patients [ 22 ]. González et al.…”

Decreased Bioimpedance Phase Angle in Patients with Diabetic Chronic Kidney Disease Stage 5

“…In many diseases, the PhA is known to be linked to nutritional status and to predict morbidity and mortality for certain diseases [1][2][3]. The PhA can also reflect the nutritional status of patients with end stage renal disease (ESRD) undergoing maintenance hemodialysis or not on dialysis [5][6][7]. The PhA has been used to study other diseases, but few studies have been conducted exclusively on patients with DMCKD stage 5.…”

“…The phase angle (PhA) is known as an indicator of cell integrity and a predictor of body cell mass, and has been suggested to be a prognostic, health, functional, and nutritional indicator of several diseases [1][2][3][4]. Of course, studies on the PhA have also been published in the area of kidney disease [5][6][7]. The PhA is a strictly objective rather than subjective measure.…”